Ankylosing Spondylitis and Pregnancy

By Mary Anne Dunkin | Updated April 27, 2022

For a woman considering pregnancy, some questions are universal — will I have severe morning sickness? Should I have natural childbirth or get an epidural? Will I use cloth diapers or disposables?  But if you have ankylosing spondylitis (AS) you probably have some unique ones — will my disease or medication affect my baby’s development? Will my symptoms worsen during pregnancy? Will arthritis affect my delivery? Will I be physically able to care for my new baby?

In most cases, the answer to these questions can be quite reassuring, says Mehret Birru Talabi, MD, PhD, assistant professor of medicine in the University of Pittsburgh’s Division of Rheumatology and Clinical Immunology.

Here’s what you should know about common concerns when you’re thinking about having a baby, during pregnancy and after the delivery.

Pregnancy Planning

There is no evidence that having ankylosing spondylitis will affect your ability to conceive. But planning ahead is important, so practice effective birth control until you decide the time is right for you to have a child. People with AS generally can use any type of birth control, although some kinds, like IUDs, do a better job of preventing pregnancy than others. Effective birth control is especially important if you take a medication that should be stopped weeks or months before pregnancy or if the drug’s effects aren’t known.

Ideally, you should discuss family planning issues with your rheumatologist early on, not just when you’ve decided you would like to start trying to have a baby, says Lisa Sammaritano, MD, a rheumatologist at Hospital for Special Surgery specializing in reproductive issues in patient with rheumatic diseases and a professor of clinical medicine with Weill Cornell Medical College.

Effects on fetal development: Planning should always involve a discussion of which medications you can and can’t safely continue during pregnancy. Fortunately, says Dr. Sammaritano, the risks of most drugs prescribed for AS end when the drug is out of your bloodstream. Neither the drugs you took in the past nor AS itself should affect the development of your baby.

This includes nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen, naproxen, celecoxib (Celebrex) and aspirin. NSAIDs are the most commonly prescribed drugs for a disease similar to AS called nonradiographic axial spondyloarthritis (nr-axSpA). Both prescription and over-the-counter NSAIDs appear safe up to 20 weeks of pregnancy, but may cause serious kidney problems in a fetus if taken longer. Before 2020, the cutoff for NSAIDs was 30 weeks, when they can damage an unborn baby’s heart.

Passing on AS: There is a genetic component to autoimmune diseases, including AS. While there’s a possibility that your child may develop AS or another autoimmune disease, it’s really important to remember that many women with autoimmune diseases have healthy babies who don’t develop any autoimmune disease.

Disease activity during pregnancy: Similarly, having a baby will not likely have a significant impact on the course of your AS. Research dating back to the late 1990s suggested that women with AS have a roughly equal chance of having their disease activity worsen, improve or stay the same during pregnancy. A 2018 study published in Rheumatology found that for women with AS, disease activity tended to stay low and stable throughout most of pregnancy with disease activity peaking in the second trimester.

Pregnancy: The Whole Nine Months

If the drugs you were taking at conception are controlling your disease, your doctor will likely have you continue them throughout pregnancy, provided they are pregnancy compatible.

AS’s effect on delivery: If arthritis affects your back or hips, you may notice more pain in those joints as your baby grows and places more stress on them. Ask if your obstetrician has experience working with women with disabilities. If possible, find out the same about the anesthesiologist who will be working with you in the delivery room. In some cases, involvement of the hips and spine could make a vaginal delivery more difficult, and inflammation of the spine could make it difficult to administer an epidural — the injection of an analgesic directly into space around the spinal cord to numb the lower half the body during delivery. You should discuss these possibilities with your doctor. Still, recent studies show that cesarean births in people with AS aren’t related to joint or spine problems but to premature birth or pre-eclampsia — a complication of pregnancy that can be life-threatening for both mom and baby.

Planning for your newborn’s care: During pregnancy it’s important to plan for the help you’ll need after you deliver. A 2021 review published in Clinical Rheumatology reported that between 30% and 100% of women with AS experience a flare in the months after delivery, which could mean you’ll need some extra help caring for your baby if that happens. Even if your disease is well controlled you may have more fatigue than other new mothers, so you’ll likely need extra help once the baby comes.

Ability to breastfeed: There’s no evidence that AS lowers milk production. However, some women experience pain when trying to hold their babies to breastfeed, especially if their AS is not well controlled. Although you can’t pass AS to your child by breastfeeding, you can pass along some medications. Many medications are safe to use in lactation, and medication passage through breastmilk is relatively low in many cases.

After Delivery

Most women with AS can expect a healthy delivery and baby.

Disease activity: If you notice worsening of symptoms, contact your rheumatologist, because a flare is more likely in the months after delivery. And even if your disease is stable, childbirth and caring for a newborn is exhausting, so fatigue is likely.

Medication and breastfeeding: If controlling your disease after delivery requires a change in medication, let your doctor know if you are breastfeeding. Many medications, but not all, are safe for breastfeeding.

Caring for baby: Taking care of yourself now is especially important — take your medications, eat healthfully, nap when the baby naps and get help from your partner, trusted family and friends, and even paid help if needed or possible. Parenthood is a challenging, lifelong job, but provides unique joys. Taking care of yourself now can help ensure your ability to care for your child in the years ahead.